I hung up the phone with the managed care case reviewer. The patient in question was in her late 50s, with multiple sclerosis and other physical problems that had unexpectedly interfered with her ability to return home or even to sit comfortably in a wheelchair. Bed-bound, she was irritable with the staff and distressed about the changes in her life, and in financial circumstances that had resulted in this new insurance coverage.
“You can see her for another 30 days,” the case reviewer told me. “After that, I’ll have to send it to a second level review.”
I sat at the desk in the administration office, hyperventilating. What else would need to happen to this resident in order to get more than a month of treatment? An amputation? The death of her only child?
I took my mind to a better place:
I was in my office at the rehabilitation and care center reviewing the psychology calendar for the month:
• This week I’d shadow the east wing staff and focus on team building.
• My weekly open office hours with the staff had several appointments already filled to discuss conflicts with coworkers, finding better ways to interact with a difficult resident, and how an otherwise excellent worker could get to work on time.
• The topic for the August family group meeting was set: How to partner with the staff.
• The monthly staff training topic was planned to coordinate: How to work with families. Other trainings I had in mind were on facing challenges such as aggressive residents, understanding mental illness, dementia without medication and team management of end-of-life care, in addition to handling work/life balance, reducing stress, time management, and coping with loss.
• The data collection for my research project was progressing nicely. Copies of my book, “The Savvy Resident’s Guide,” had been distributed to the recreation therapists, who were using them to run discussion groups with the residents based on chapter topics such as “Working with the staff” and “Making the most of rehabilitation.” Residents were being measured on acquired knowledge, level of anxiety, conflicts with staff and participation in rehab.
• My rehab morning was scheduled to observe interactions between the residents and the therapists and to offer suggestions for using psychology to help residents get the most out of rehabilitation services.
• I was meeting later in the week with a group of newly admitted rehab residents to address stress management. According to the charge nurse on the unit, several of the residents were quite anxious and taking a lot of staff time and attention about nonmedical issues.
• I had about a dozen residents on my roster to see individually; the other psychologists had similar caseloads in addition to their meetings and trainings. I needed to put together a report for the administrator about the state of customer service based on my observations and formulate a plan to enhance it. I planned to ask him about whether he’d consider me for a new title: Dr. El, Chief Experience Officer for LTC.
“Dr. Barbera? Dr. Barbera?” The administrator looked at me, alarmed. He must have been staring at me for a while before I noticed.
“I’m fine,” I said, shaking myself out of my reverie. “I just got some bad news, that’s all.”
Eleanor Feldman Barbera, PhD, author of The Savvy Resident’s Guide, is a 2014 Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is the Gold Medalist in the Blog-How To/Tips/Service category of the 2014 American Society of Business Publication Editors Midwest Regional competition. A speaker and consultant with nearly 20 years of experience as a psychologist in long-term care, she maintains her own award-winning website at MyBetterNursingHome.com.